With the population in the Gulf Coast region expected to exceed 8 million by 2025, we are confronted with a critical question: Will there be enough Level 1 trauma centers to handle the serious emergencies sure to accompany that exponential increase? How we answer will largely determine if we put our region at serious risk by ignoring the problem or confront the issue head on and work toward a solution.

To put the matter into stark perspective, the Philadelphia metropolitan area, with its population of 6 million, has seven Level 1 trauma centers. The Houston-Galveston region, with the welcomed redesignation of the Level 1 trauma center at the University of Texas Medical Branch at Galveston, currently has three, including Ben Taub and Memorial Hermann. The American College of Surgeons recommends that there be one Level 1 trauma center for every 1 million people, urgently underscoring our area's enormous need for more such centers.

A trauma center is scored Level 1 — the highest designation — because it has every available medical specialty in house at all times to care for the most severely injured patients, including mass casualties. And while they are expensive to operate, they are nonetheless essential to the health of our region.

In 2008, we experienced firsthand the consequences of losing one of our Level 1 trauma centers when Hurricane Ike forced UTMB to cease providing emergency services. The trauma teams at Ben Taub and Memorial Hermann heroically filled the void. But treating the overflow was a Herculean task, analogous to two people struggling to lift a 500-pound rock, as one ER physician said.

In the weeks following Ike, Memorial Hermann became the busiest Level 1 trauma center in the nation, surpassing those in New York, Los Angeles and Chicago, and Ben Taub reported a significant jump in the number of out-of-county patients who might have sought care at UTMB. Memorial Hermann's emergency center, which typically averaged 450 trauma admissions a month, saw that number jump to 600 in October 2008. The increased volume of patients forced the hospital to go on trauma diversion an average of 25 percent of the time, and it stayed that way until UTMB came back online.

Here's the reality check: When a hospital is on diversion, it cannot take more patients, and ambulances are forced to take critically ill patients elsewhere - delaying care and risking lives. The American College of Surgeons guidelines recommend hospitals be on trauma diversion less than 5 percent of the time.

Now that UTMB has regained its Level 1 status, critically injured patients in the region are more likely to get the help they need within that precious "golden hour." Having this third trauma center fully operational improves access to critical care for residents along the coast because UTMB's Galveston location means the difference between a 30-minute and a 60-minute helicopter ride for a critically injured worker from a nearby petrochemical plant or offshore oil rig.

The importance of the trauma-center safety net was never more evident than in March 2005, when BP's Texas City refinery exploded, killing 15 workers and injuring more than 170. Twenty-three of the most critically injured were treated at UTMB, including several who were airlifted in for quick medical care. All 23 survived.

A look back at Hurricane Katrina also underscores the critical role Level 1 trauma centers play for residents of the Texas Gulf Coast. Although higher patient volume post-Ike was a challenge for the Harris County Hospital District, its two-week operation of the Katrina Health Clinic in September 2005 illustrated the major impact that increased demand for services has on such centers. Clinic operations, staff and physical structure quadrupled during the first 72 hours, with more than 11,000 patient visits, 10,000 prescriptions and 10,000 tetanus shots recorded. Within one year of the storm, the hospital district had logged nearly 31,000 evacuee patient visits in its facilities, including 442 admissions to its hospitals.

These examples illustrate that although the return of UTMB provides a temporary sense of security for our trauma center safety net, our region is still woefully underserved and growing more so every day.

There's a mechanism in place to help. Since 1993, the Designated Trauma Facility and EMS fund has helped offset uncompensated trauma care costs in designated trauma facilities. Since 2004, a portion of the proceeds from the Driver Responsibility Program have been the main source of funding. Unfortunately, since 2006, only a portion of the funds collected have been appropriated and distributed.

And, by the end of the current biennium, the fund is projected to have collected some $300 million not appropriated to support the state's safety-net hospitals like UTMB, Memorial Hermann and Ben Taub.

This is unacceptable. Having a statewide trauma system benefits everyone, and the state should support this resource with funds intended for that purpose. Simply put, we must strengthen the state's trauma system safety net. Otherwise, we run the serious risk of stretching it too thinly and reducing survival rates for critically injured patients in the region. Left unchecked, the safety net that we all depend on when minutes count will fail.

Callender is president of the University of Texas Medical Branch at Galveston; Lopez is president and CEO, Harris County Hospital District; Wolterman is president and CEO, Memorial Hermann Healthcare System.